surgeon 100% demands muscle relaxant, patient can't tolerate lying flat or demands to be asleep and I absolutely have to do GA....
i'll bite and go with the awake fiberoptic (argument is maybe a difficult vent and difficult tube in a guy with LITTLE reserve, if he goes down, he goes down hard)
downside I think to AFIO in this is the schizo and possible HTN/tachy increasing O2 demand
somewhat co-operative....good counseling and assurance and hand holding....18 g IV, glyco .4 , start dex infusion .7, epidural, inhaled 4% lido while aline goes in, paint tonsillar pillars with viscous lido, 5-7 cc 2% lido to get check epidural, AFOI (spray cords with 4% lido , back out, wait a min, do it again), ketamine bolus as back up if he is freaking out, esmolol/nitroG dilute bolus to keep him from having MI if he does freak out, once tube in 20-30 prop and some sevo
intraop:
start titrating up the epidural with 2% lido so surgeon can start up, start my epidural infusion, sevo (no nitrous - pA htn, no dez - irritate) , Pressure control, minimize Fio2, peep 6-7, peak/plateau pressures will probably be a littler higher is really restrictive disease, don't let him breath-stack, adjust IE ratio, minimize fluids, avoid hypotension/tachycardia, don't give too much rock and check his twitches, check an abg every once in a while, heck maybe a BIS just to minimize his anesthetic (if schizo is a risk factor for post op delerium)
emergence: get this guy breathing early on PSV, make sure he is reversed (we have sugammadex now which is cool), if everything looks good (uncomplicated procedure, minimal fluid, no BP issues, good volumes, minimal suport, good abg) I would try to extubate (head up position, maybe even right to bipap) in a controlled environment with some backup tools around (fiber optic , glide, maybe even an extra hand around)
i'm sure I just opened myself up to tons of critique and pimp questions but its fun...